Where do typical confluent drusen often form?

Typical confluent drusen often form between the retinal pigment epithelium (RPE) basement membrane and the inner collagenous layer of Bruch's membrane. This location is significant because drusen consist of various proteins, lipids, and other materials that accumulate in this area, which can disrupt the normal function of the RPE and contribute to the pathophysiology of age-related macular degeneration (AMD). The relationship between the RPE and Bruch's membrane is crucial for the metabolic exchange between the retina and the underlying choroid, and the presence of drusen can lead to impaired nutrient transport and waste removal, ultimately impacting retinal health.

The formation of drusen in this specific area is particularly concerning because as they grow and become confluent, they can lead to further complications such as geographic atrophy or choroidal neovascularization, both associated with progressive vision loss. Understanding this relationship helps in the diagnosis and management of AMD and other retinal diseases where drusen formation is a notable finding.